36 Which Psychological Factors Exacerbate Irritable Bowel Syndrome? Test of a Comprehensive Model

Abstract

Background: It has been demonstrated that usual medical care for IBS emphasizes education and lifestyle modification more than drugs in the US (Whitehead et al. Aliment Pharmacol Ther 2004). No studies have compared directly how IBS patients are managed in the US vs. other countries. Our aims were to compare the usual medical care for IBS in the US and Japan. Methods: 1762 patients in the US (73% of females) and 376 patients in Japan (50% of females) were recruited from primary care and GI clinics. They completed postal questionnaires within two weeks after a doctor visit at which they received a diagnosis of IBS. Questionnaires used in the Whitehead et al study were translated into Japanese and validated; they included the Rome II modular questions for IBS diagnosis, the IBS severity scale (IBS-SS), the IBS-QOL, ratings of confidence in their doctors (0 to 100) and satisfaction with treatment (0 to 100). They also reported which treatments their doctors recommended and whether they received education and reassurance about IBS. Results: IBS clinic patients in Japan (n=200) were younger (41±17 vs. 51±14 yrs) and more likely to be males (62% vs. 23%) compared to US patients (n=665). There was no difference in overall IBS severity (230±112 in Japan vs. 239±116 in the US), but Japanese patients had lower IBS-QOL (69±22, vs. 73±21, p=0.01). Diet and exercise recommendations were less frequent in Japan (Table), perhaps reflecting lower rates of obesity. Drug treatment of IBS was more aggressive in Japan, with significantly greater use of anxiolytics. Motility agents were prescribed to 71% of Japanese IBS patients but were not even on the formulary in the US clinics where this study was done. Japanese IBS patients were also more likely than US patients to receive education (97% vs. 56%, p<0.01) and reassurance (74% vs. 48%, p<0.01). Japanese patients reported greater confidence in their doctor's treatment recommendations (88±15 vs. 66±31, p<0.01) and greater satisfaction with treatment (73±20 vs. 65±26, p<0.01). Conclusions: IBS is treated more aggressively in Japan where the majority of IBS clinic patients are males, and Japanese patients are more satisfied with their treatment. [Supported by R01 DK31369] Treatment recommended by doctors for IBS symptoms